5.10 Venous Insufficiency
Overview
Venous insufficiency is a condition that occurs when the veins in the legs have difficulty returning blood back to the heart. Veins have one-way valves that help blood flow in the right direction. When the valves are weakened or damaged, blood can pool in the veins. Various conditions can cause venous insufficiency, including deep vein thrombosis, varicose veins, age, obesity, and pregnancy. Occupations that require individuals to sit for longer periods of time may also predispose clients to venous insufficiency.[1]
Assessment
Signs of venous insufficiency may vary based upon the severity of the venous involvement. Clients may experience swelling, especially noted in the ankles and lower legs. Swelling typically worsens throughout the day. Many clients may also report aching or pain in the affected extremity. The pain is often described as throbbing or cramping. Many clients with venous insufficiency may also report fatigue or feelings of heaviness in the legs. Some individuals may experience itching or tingling in the legs, and skin color in the affected area may appear dark or discolored. The skin texture may also change and appear dry or rough, taking on a scaly appearance. The veins of the impacted extremities may also appear enlarged and tortuous, visible near the surface of the skin. For individuals with severe cases of venous insufficiency, open sores or ulcers may develop.[2]
Diagnostic Testing
Diagnostic testing for venous insufficiency includes methods to assess the functionality of the venous system. Providers may order ultrasound or Doppler flow studies to examine the direction and flow patterns of the blood. If more definitive identification of restricted vessel areas is needed, a venography may be performed. In this procedure, contrast dye is injected into the large veins of the leg, and X-ray images are collected to provide more comprehensive images of the venous system.[3]
Nursing Diagnoses
Nursing diagnoses for venous insufficiency focus on managing symptoms and reducing the risk of complications. Common nursing diagnoses include the following:
- Impaired Skin Integrity
- Chronic Pain
- Activity Intolerance
Outcome Identification
Outcome identification involves setting short- and long-term goals and creating expected outcome statements tailored to the client’s specific needs. These outcomes should be measurable and responsive to nursing interventions.
Sample expected outcomes for common nursing diagnoses related to venous insufficiency are as follows:
- The client will exhibit improved skin integrity with the absence of new ulcerations or wounds within two weeks.
- The client will experience a reduction in chronic pain levels, achieving a pain rating of 2-3 or below within three days.
- The client will demonstrate improved tolerance to physical activity, achieving the ability to perform walk 300 feet without undue fatigue within one week.
Interventions
Medical Interventions
Medical interventions